Provider Demographics
NPI:1336202134
Name:MENDIOLA, VICTOR O (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:O
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-1205
Mailing Address - Country:US
Mailing Address - Phone:713-697-4705
Mailing Address - Fax:713-697-4763
Practice Address - Street 1:1415 N LOOP W
Practice Address - Street 2:SUITE 940
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:713-697-4705
Practice Address - Fax:713-697-4763
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127001904Medicaid
TX127001905Medicaid
TX127001905Medicaid
TX760511222OtherEIN
$$$$$$$$$OtherSOCIAL SECURITY
TX127001905Medicaid